Chapter 12 Assignment

You are the supervisor of a surgical services department in a nonunion hospital. The staff on your unit have become increasingly frustrated with hospital policies regarding staffing ratios, on-call pay, and verbal medical orders but feel that they have limited opportunities for providing feedback to change the current system. You would like to explore the possibility of moving toward a shared governance model of decision making to resolve the issue and others like it but are not quite sure where to start.Instructions:1. Review Learning Exercise 12.6 – Problem Solving: Working Toward Shared Governance (located in Chapter 12 of the textbook)2. Answer the following questions: a. Who do I need to involve in the discussion and at what point? b. How might I determine if the overarching organizational structure supports shared governance? • How would I determine if external stakeholders would be impacted? • How would I determine if organizational culture and subculture would support a shared governance model? c. What types of nursing councils might be created to provide a framework for operation? d. Who would be the members on these nursing councils? e. What support mechanisms would need to be in place to ensure success of this project? f. What would be my role as a supervisor in identifying and resolving employee concerns in a shared governance model? 3. Your paper should be: o Typed according to APA style for margins, formatting and spacing standards. o Typed into a Microsoft Word document, save the file, and then upload the file
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R ESEARCH COR N ER
Exploring how nurses and managers
perceive shared governance
By Janet Wilson, BSN, RN; Karen Gabel Speroni, PhD, RN;
Ruth Ann Jones, EdD, MSN, RN, NEA-BC; and Marlon G. Daniel, MPH, MHS
Abstract
Background: Nurse managers have a pivotal role in the success of unitbased councils, which include direct care nurses. These councils establish
shared governance to provide innovative, quality-based, and cost-effective
nursing care. Purpose: This study explored differences between direct care
nurses’ and nurse managers’ perceptions of factors affecting direct care
nurses’ participation in unit-based and general shared governance activities
and nurse engagement. Methods: In a survey research study, 425 direct care
RNs and nurse managers were asked to complete a 26-item research
survey addressing 16 shared governance factors; 144 participated
(response rate = 33.8%). Results: Most nurse participants provided direct
care (N = 129, 89.6%; nurse managers = 15, 10.4%), were older than
35 (75.6%), had more than 5 years of experience (76.4%), and worked
more than 35 hours per week (72.9%). Direct care nurses’ and managers’
perceptions showed a few significant differences. Factors ranked as very
important by direct care nurses and managers included direct care nurses
perceiving support from unit manager to participate in shared governance
activities (84.0%); unit nurses working as a team (79.0%); direct care nurses
participating in shared governance activities won’t disrupt patient care
(76.9%); and direct care nurses will be paid for participating beyond
scheduled shifts (71.3%). Overall, 79.2% had some level of engagement in
shared governance activities. Managers reported more engagement than
direct care nurses. Conclusions: Nurse managers and unit-based councils
should evaluate nurses’ perceptions of manager support, teamwork, lack
of disruption to patient care, and payment for participation in shared
governance-related activities. These research findings can be used to evaluate
hospital practices for direct care nurse participation in unit-based shared
governance activities.
Background
Hospitals are continuously seeking
opportunities to improve their performance by providing innovative,
quality-based, cost-effective care.
Principles of shared governance have
been integrated in nursing infrastructures as a means of providing a transformational framework for direct care
nursing staff and improving an organization’s overall performance. The
three core principles associated with
shared governance are as follows:
www.Nursing2014.com
1. Responsibilities for nursing care
delivery must reside with clinical
staff.
2. Authority for nurses to act must
be recognized by the organization.
3. Accountability for quality patient
care and professionalism must be
accepted by the clinical staff.1
Shared governance activities give
direct care nurses an opportunity to
partner with nursing management to
achieve optimal patient outcomes
and to increase nurse job satisfaction,
nurse productivity, and nurse retention.2 Shared governance provides
the framework for a collaborative
environment of nursing leaders and
direct care nurses. Together, they can
formulate a partnership of shared
decision making for clinical and
operational practices.3
Direct care nurses play a vital role
in helping realize the objectives set
forth in the 2010 Affordable Care
Act.4 Nurses need to overcome barriers that prevent them from responding effectively to rapidly changing
healthcare settings.
Direct care nurses’ and nurse managers’ perceptions of direct care
nurse participation in shared governance need to be explored. When
direct care nurses and nurse managers recognize differences in their perceptions, ideally they can improve
unit-based and overall shared governance by leveraging the diversity
that these two different perspectives
can provide to improve patient
outcomes.
The literature lacks an examination of direct care nurse or nurse
manager factors perceived as important for direct care nurse participation in unit-based and overall shared
governance activities. Also absent is a
delineation of identifiable differences
by nurse job responsibilities and factors important to both direct care
nurses and nurse managers for direct
care nurse participation in shared
governance.
For the literature review, PubMed,
EBSCOhost, ProQuest, and the
July l Nursing2014 l 19
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
R ESEARCH COR N ER
Cochrane Library databases were
searched for the years 2006 to 2012.
Search terms included engagement,
physician-nurse relationship, relationshipbased care, shared governance, staff
nurse participation, participation, barriers, and positive nursing workforce
environments.
This survey study was conducted
to identify factors that could be used
by nurse managers and shared governance leaders (unit council chairs)
to strengthen direct care nurse participation in shared governance
activities at the unit level. The
researchers created the study survey
based on factors about shared governance derived from the literature
review and hospital direct care
nurses’ perceptions.
The study was conducted at Shore
Health System, a two-hospital, not-
for-profit, rural healthcare system
located in Easton and Cambridge,
Md. The healthcare system, which
obtained American Nurses Credentialing Center (ANCC) Magnet®
recognition in October 2009 and
redesignation in 2014, has 188
licensed beds and employs about
500 nurses. Members from the hospitals’ nursing research council
served as the 11-member panel that
performed content validity for relevance and clarity of a 26-item survey. (See Glossary of research terms.)
Members rated each survey question
according to a 4-option relevance
scale (1 = not relevant, 2 = somewhat
relevant but unable to assess question relevance without major revisions, 3 = quite relevant but needs
minor revisions, and 4 = relevant).
The panel also rated the clarity of
Glossary of research terms
• Bonferonni corrections. A statistical adjustment used in the case of multiple
simultaneous comparisons to reduce the chance of committing a type I error
(the probability of rejecting the null hypothesis when it’s true).
• Chi-square analysis. A statistical method used to test the association between
two nominal variables based upon the Chi-square distribution.
• Content validity. Measures how well a particular scale or indicator variable
explains or represents a theoretical construct.
• Convenience sampling. A nonprobability-based method of sampling that
each question on the survey according to a 4-option clarity scale (1 =
not clearly written with no potential
for revision, 2 = not clearly written
and needs major revision, 3 = clearly
written, but needs minor revision,
and 4 = clearly written). The panel
received content validity forms for
the survey, a copy of the survey, the
study abstract, and instructions for
evaluating the survey. Based on
panel responses, questions with
80% or greater agreement about
question relevance and clarity
were retained, and those with less
than 80% agreement were revised.
The final panel review generated a
scale content validity index of .94
for the 26-item survey (demographics = 8 items; shared governance activities = 1; engagement
level = 1; and shared governance
perception factors = 16).
Purpose
The study’s purpose was to explore
differences between direct care
nurses’ and nurse managers’ perceptions of specific factors that could
affect the direct care nurses’ participation in unit-based and general
shared governance activities. Factors
associated with direct care nurse
engagement were also explored.
selects individuals based on accessibility.
• Fisher exact tests. Similar to a Chi-square test in that it’s testing the association between two nominal variables, where the nominal variables have only two
categories.
• Frequency distribution. The classification of all values in a particular variable
that are collected in a study.
• Likert scale. A symmetric rating scale that allows respondents to indicate their
agreement with a stated question or construct.
• P value. The probability that a sample’s effect or estimate is as large or larger
in the population given that the null hypothesis is true.
• Scale content validity index. The degree to which a scale’s content validity
assesses the underlying construct(s) being measured.
• Selection bias. A systematic bias in the statistical results of a study that’s
attributed to the selection of study participants.
Methods
In this survey research study, data
were collected from September to
November 2011. Inclusion criteria
for the study included direct care
nurses and nurse managers who
were employed in the categories of
full-time, part-time, relief, or weekends. Nurses who were employed on
a per diem or temporary basis were
excluded.
The principal researcher delivered
study packets to eligible nurses’
unit-based mailboxes. The study
packet consisted of a one-page letter
20 l Nursing2014 l July
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
www.Nursing2014.com
describing the study, the institutional review board-approved
informed consent form, the survey
instrument, and an interoffice envelope preaddressed to the researcher.
Of the 425 eligible direct care
nurses and nurse managers asked to
participate, 144 returned surveys
(response rate = 33.8%).
The 26-item survey asked nurses
to self-report perceptions of activities
in which they’d participated over
the past year and their level of
engagement. For purposes of this
research, engaged was defined as a
nurse who’s fully involved and
enthusiastic about his or her work
and who acts in a way that furthers
nursing on the unit.
The survey also asked nurses 16
questions associated with their perception of the importance of several
specified factors that affect direct care
nurse participation in shared governance activities. These were measured with a 5-point Likert scale
(1 = not at all important; 2 = not very
important; 3 = neutral; 4 = somewhat
important; and 5 = very important).
The study was continued until a
minimum target sample of surveys
had been received (N = 128), or
30% of the system’s eligible 403
direct care RNs (N = 121) and 22
nurse managers (N = 7). The study
was designed to let the target
sample size be met; additional
surveys were received during
this time.
Statistical analyses were completed
using SAS (version 9.1.3, Cary, NC).
Frequencies distributions were calculated to describe the survey items. In
addition, Fisher exact tests and Chisquare analysis examined the differences and associations between the
study groups for each study item/
response. Bonferonni corrections
were used in cases of multiple comparisons to reduce error.
www.Nursing2014.com
Results
Of the 144 nurses participating in
this study, 129 (89.6%) were direct
care nurses and 15 (10.4%) were
managers. Most participants were
over age 35 (75.6%), had an associate’s degree (37.5%), had more than
5 years of experience (76.4%), and
worked more than 35 hours per
week (72.9%).
Direct care nurses and managers
differed significantly in their education, years of experience, and hours
worked per week. Managers were
typically older and had more education and more experience. The
largest percentages of nurses who
participated in the survey worked in
the ED (15.3%) and medical/surgical/
oncology unit (12.5%). No significant differences in the survey results
were seen between the two system
hospitals.
Two significant differences in
direct care nurses’ and managers’
perceptions for the shared governance factors evaluated were noted:
“direct care nurses perceiving nurses
on the unit work as a team” in the
response category of “very important” (direct care nurses = 76.6%,
managers = 100%, P = 0.05); and
“direct care nurses feeling they have
the ability to make changes at unit
level,” also for the response category
of “very important” (direct care
nurses = 62.0%, managers = 93.3%,
P = 0.05).
The top four factors ranked as
“very important” overall (direct care
nurse and nurse manager responses
combined) were:
1. direct care nurses perceiving support by unit manager (very important overall = 84.0%, direct care
nurses = 83.0%, managers = 93.3%)
2. direct care nurses perceiving nurses
on unit work as team (very important
overall = 79.0%, direct care nurses =
76.6%, managers = 100%, P = 0.05)
3. direct care nurses feeling time to
participate in activities without
disrupting patient care (very important overall = 76.9%, direct care
nurse = 75.8%, managers = 86.7%)
4. direct care nurses believing they’ll be
paid for activities beyond scheduled
shift (very important overall = 71.3%,
direct care nurses = 72.7%, manager =
60.0%).
Regarding activity participation
during the previous year, managers
reported a higher participation rate
for 11 of the 12 activities measured;
of these, all but three were statistically significant. Direct care nurses
reported more activity for only one
category, which was “charge nurse
when designated” (direct care nurse
= 68%; manager = 33.3%). Regarding engagement level, 79.2% of
participants had some level of
engagement. A significantly higher
percentage of managers were very
engaged compared with direct care
nurses (direct care nurses = 36.4%;
managers = 86.7%).
Discussion
As a result of this research, four
primary factors were identified
that were perceived by direct care
nurses and nurse managers to
influence direct care nurse participation in shared governance activities. (See What factors influence
shared governance participation?)
Ideally, to strengthen direct care
nurse participation in shared
governance activities both at
the unit level and in general,
nurse managers need to focus
on the following:
• supporting direct care nurses’
participation in shared governance
activities
• ensuring unit nurses work as an
effective team
• ensuring that no disruptions to
patient care occur as a result of
July l Nursing2014 l 21
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
R ESEARCH COR N ER
What factors influence shared governance participation?
TEAMWORK
Unit nurses work as
an effective team
SUPPORT
Nurse managers
provide support for
direct care nurses to
participate in shared
governance activities
OPTIMAL PATIENT
CARE
Participation in
shared governance
doesn’t disrupt
patient care
Direct care nurse
participation in
unit-based and
overall shared
governance
activities
nurses participating in shared
governance activities
• ensuring that nurses are paid for
participation in shared governance
activities.
Our findings support shared
governance survey research that
assessed the knowledge, commitment, and perception of shared governance.5 These earlier research
results showed a need to enhance
enabling factors and to reduce the
barriers associated with shared governance. Shared governance
enabling factors were continued
management support, providing
council members time to do their
work, and providing education to
council participants on the roles and
processes of shared governance.
This additional focus on shared
governance activities will enhance
the opportunity for direct care
nurses and managers to evaluate
their partnerships aimed at achieving optimal patient outcomes and
increasing nurse job satisfaction,
nursing productivity, and nursing
retention.2
Additional research is needed to
define clear shared governance out-
COMPENSATION
Direct care nurses are
paid for participation
in shared governance
activities
comes and attributes such as participation, scope of decisions, and
level of authority to lead to the
implementation of strategies that
may predict the long-term success
of shared governance within organizations.5 The traditional approach
to engaging direct care staff nurses
in daily activities also needs to be
studied if managers are conducting
more quality improvement activities, evidence-based practice projects, and research studies than
direct care nurses. Research is also
needed to identify relationships
between shared governance (the
degree to which it’s present in an
organization) and the organization’s
outcomes, such as those nursing
sensitive indicators reported in
national databases.
A limitation of this study is the
selection bias inherent with survey
research designs employing convenience sampling. Nurses participating in this survey may have been
more engaged than nurses who
chose not to participate. Also, these
findings may not be generalizable
to hospitals in nonrural settings or
to those without ANCC Magnet
recognition. Also, a limited number
of nurse managers were included in
this study. Research in larger hospital systems having more nurses and
managers is suggested.
Conclusions
Based on these study findings,
nurse managers and unit council
leaders/members should evaluate
their nurses’ perceptions of manager support, teamwork, lack of
disruption to patient care, and pay
for their participation in shared
governance-related activities. These
research findings can be used to
facilitate evaluation of hospital
practices for direct care nurse participation in unit-based shared governance activities. ¦
REFERENCES
1. Anderson EF. A case for measuring governance.
Nurs Adm Q. 2011;35(3):197-203.
2. Frith K, Montgomery M. Perceptions, knowledge, and commitment of clinical staff to shared
governance. Nurs Adm Q. 2006;30(3):273-284.
3. Gavin M, Ash D, Wakefield S, Wroe C. Shared
governance: time to consider the cons as well as the
pros. J Nurs Manag. 1999;7(4):193-200.
4. Howell JN, Frederick J, Olinger B, et al. Can
nurses govern in a government agency? J Nurs Adm.
2001;31(4):187-195.
5. Institute of Medicine. The Future of Nursing:
Leading Change, Advancing Health. Washington, DC:
The National Academies Press; 2010.
At Shore Health System in Easton, Md., Janet Wilson
is the chair of nursing shared leadership and faculty
for Critical Care and Graduate University (a hospitalbased nurse residency program); Karen Gabel
Speroni is chair of the nursing research council; Ruth
Ann Jones is director of acute care; and Marlon G.
Daniel is a statistician and faculty for Critical Care and
Graduate University.
Research Corner is coordinated by Cheryl Dumont,
PhD, RN, CRNI, director of nursing research and the
vascular access team at Winchester Medical Center in
Winchester, Va. Dr. Dumont is also a member of the
Nursing2014 editorial board.
The content in this article has received appropriate
institutional review board and/or administrative
approval for publication.
The authors have disclosed that they have no
financial relationships related to this article.
DOI-10.1097/01.NURSE.0000450791.18473.52
22 l Nursing2014 l July
Copyright © 2014 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.
www.Nursing2014.com
Chapter 12 – Assignment
You are the supervisor of a surgical services department in a nonunion
hospital. The staff on your unit have become increasingly frustrated with
hospital policies regarding staffing ratios, on-call pay, and verbal medical
orders but feel that they have limited opportunities for providing feedback to
change the current system. You would like to explore the possibility of
moving toward a shared governance model of decision making to resolve the
issue and others like it but are not quite sure where to start.
Instructions:
1. Review Learning Exercise 12.6 – Problem Solving: Working Toward Shared
Governance (located in Chapter 12 of the textbook)
2. Answer the following questions:
a. Who do I need to involve in the discussion and at what point?
b. How might I determine if the overarching organizational structure supports
shared governance?
• How …
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